Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type

PROSPR consortium

Research output: Contribution to journalArticle

Abstract

Introduction: The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same healthcare systems. Methods: A total of 35,009 patients aged 50–64years with a positive fecal immunochemical test were evaluated in Northern and Southern California Kaiser Permanente systems and in a North Texas safety-net system between 2011 and 2012. Kaplan–Meier estimation was used between 2016 and 2017 to calculate the probability of having follow-up colonoscopy by coverage type. Among Kaiser Permanente patients, Cox regression was used to estimate hazard ratios and 95% CIs for the association between coverage type and receipt of follow-up, adjusting for sociodemographics and health status. Results: Even within the same integrated system with organized follow-up, patients with Medicaid were 24% less likely to complete follow-up as those with commercial insurance. Percentage receiving colonoscopy within 3 months after a positive fecal immunochemical test was 74.6% for commercial insurance, 63.10% for Medicaid only, and 37.5% for patients served by the integrated safety-net system. Conclusions: This study found that patients with Medicaid were less likely than those with commercial insurance to complete follow-up colonoscopy after a positive fecal immunochemical test and had longer average times to follow-up. With the future of coverage mechanisms uncertain, it is important and timely to assess influences of health insurance coverage on likelihood of follow-up colonoscopy and identify potential disparities in screening completion.

Original languageEnglish (US)
Pages (from-to)e143-e152
JournalAmerican Journal of Preventive Medicine
Volume56
Issue number5
DOIs
StatePublished - May 1 2019

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Health Insurance
Early Detection of Cancer
Colorectal Neoplasms
Medicaid
Colonoscopy
Insurance
Safety
Insurance Coverage
Health Status
Delivery of Health Care

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

Cite this

Time to Follow-up After Colorectal Cancer Screening by Health Insurance Type. / PROSPR consortium.

In: American Journal of Preventive Medicine, Vol. 56, No. 5, 01.05.2019, p. e143-e152.

Research output: Contribution to journalArticle

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abstract = "Introduction: The purpose of this study was to test the hypothesis that patients with Medicaid insurance or Medicaid-like coverage would have longer times to follow-up and be less likely to complete colonoscopy compared with patients with commercial insurance within the same healthcare systems. Methods: A total of 35,009 patients aged 50–64years with a positive fecal immunochemical test were evaluated in Northern and Southern California Kaiser Permanente systems and in a North Texas safety-net system between 2011 and 2012. Kaplan–Meier estimation was used between 2016 and 2017 to calculate the probability of having follow-up colonoscopy by coverage type. Among Kaiser Permanente patients, Cox regression was used to estimate hazard ratios and 95{\%} CIs for the association between coverage type and receipt of follow-up, adjusting for sociodemographics and health status. Results: Even within the same integrated system with organized follow-up, patients with Medicaid were 24{\%} less likely to complete follow-up as those with commercial insurance. Percentage receiving colonoscopy within 3 months after a positive fecal immunochemical test was 74.6{\%} for commercial insurance, 63.10{\%} for Medicaid only, and 37.5{\%} for patients served by the integrated safety-net system. Conclusions: This study found that patients with Medicaid were less likely than those with commercial insurance to complete follow-up colonoscopy after a positive fecal immunochemical test and had longer average times to follow-up. With the future of coverage mechanisms uncertain, it is important and timely to assess influences of health insurance coverage on likelihood of follow-up colonoscopy and identify potential disparities in screening completion.",
author = "{PROSPR consortium} and Nancy Breen and Skinner, {Celette S} and Yingye Zheng and Stephen Inrig and Corley, {Douglas A.} and Beaber, {Elisabeth F.} and Mike Garcia and Jessica Chubak and Chyke Doubeni and Quinn, {Virginia P.} and Haas, {Jennifer S.} and Li, {Christopher I.} and Wernli, {Karen J.} and Klabunde, {Carrie N.}",
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AU - PROSPR consortium

AU - Breen, Nancy

AU - Skinner, Celette S

AU - Zheng, Yingye

AU - Inrig, Stephen

AU - Corley, Douglas A.

AU - Beaber, Elisabeth F.

AU - Garcia, Mike

AU - Chubak, Jessica

AU - Doubeni, Chyke

AU - Quinn, Virginia P.

AU - Haas, Jennifer S.

AU - Li, Christopher I.

AU - Wernli, Karen J.

AU - Klabunde, Carrie N.

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